现有的原发性肝癌分期系统是否适用于肝细胞癌-肝内胆管癌？
Do the existing staging systems for primary liver cancer apply to combined hepatocellular carcinoma-intrahepatic cholangiocarcinoma?
机构信息
Department of Liver Surgery, Liver Cancer Institute, Zhongshan Hospital, and Key Laboratory of Carcinogenesis and Cancer Invasion (Ministry of Education), Fudan University, Shanghai 200032, China.
Department of Pathology, Zhongshan Hospital, Fudan University, Shanghai 200032, China.
出版信息
Hepatobiliary Pancreat Dis Int. 2021 Feb;20(1):13-20. doi: 10.1016/j.hbpd.2020.10.002. Epub 2020 Oct 27.
BACKGROUND
The incidence of combined hepatocellular carcinoma-intrahepatic cholangiocarcinoma (cHCC-ICC) is relatively low, and the knowledge about the prognosis of cHCC-ICC remains obscure. In the study, we aimed to screen existing primary liver cancer staging systems and shed light on the prognosis and risk factors for cHCC-ICC.
METHODS
We retrospectively reviewed 206 cHCC-ICC patients who received curative surgical resection from April 1999 to March 2017. The correlation of survival measures with the histological types or with tumor staging systems was determined and predictive values of tumor staging systems with cHCC-ICC prognosis were compared.
RESULTS
The histological type was not associated with overall survival (OS) (P = 0.338) or disease-free survival (DFS) (P = 0.843) of patients after curative surgical resection. BCLC, TNM for HCC, and TNM for ICC stages correlated with both OS and DFS in cHCC-ICC (all P < 0.05). The predictive values of TNM for HCC and TNM for ICC stages were similar in terms of predicting postoperative OS (P = 0.798) and DFS (P = 0.191) in cHCC-ICC. TNM for HCC was superior to BCLC for predicting postoperative OS (P = 0.022) in cHCC-ICC.
CONCLUSION
The TNM for HCC staging system should be prioritized for clinical applications in predicting cHCC-ICC prognosis.
背景
肝细胞癌-胆管细胞癌（cHCC-ICC）的发病率相对较低，其预后知识仍不清楚。本研究旨在筛选现有的原发性肝癌分期系统，并探讨 cHCC-ICC 的预后及危险因素。
方法
我们回顾性分析了 1999 年 4 月至 2017 年 3 月接受根治性手术切除的 206 例 cHCC-ICC 患者。确定生存措施与组织学类型或肿瘤分期系统的相关性，并比较肿瘤分期系统对 cHCC-ICC 预后的预测价值。
结果
根治性手术后，组织学类型与患者的总生存（OS）（P=0.338）或无病生存（DFS）（P=0.843）无关。BCLC、HCC 的 TNM 分期和 ICC 的 TNM 分期均与 cHCC-ICC 的 OS 和 DFS 相关（均 P<0.05）。在预测 cHCC-ICC 的术后 OS（P=0.798）和 DFS（P=0.191）方面，HCC 的 TNM 分期和 ICC 的 TNM 分期的预测价值相似。在 cHCC-ICC 中，TNM 分期对 HCC 优于 BCLC 预测术后 OS（P=0.022）。
结论
在预测 cHCC-ICC 的预后方面，HCC 的 TNM 分期系统应优先用于临床应用。
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